Summary

Effective January 1st, 2014, the California Division of Workers’ Compensation (DWC) adapted Medicare CPT/HCPCS Status Codes to further provide reimbursement information for various Procedure Codes.

Section 9789.12.3 mandates specific guidelines for status codes C, I, N, and R.

For C, N, and R Status Codes:

1. Use the CMS Relative Value Units (RVUs) to calculate reimbursements.
2. When there is no RVU assigned, services are reimbursed By Report.

For I Status Codes:

1. The service or product is reimbursed according to the CPT code.
2. If an HPCPCS “J” code is used, the code is reimbursed according to section 9789.13.2.

If the above is nonapplicable:

1. Use the RVUs to calculate reimbursements.
2. If the above is not applicable, refer to the regulations in sections 9789.30 - 9789.70.
3. If both of the above are not applicable, the code is payable By Report.

California Code of Regulations (CCR)

§ 9789.12.3 Status Codes C, I, N and R

Division of Workers’ Compensation Websites

Official Medical Fee Schedule

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